SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
SUMMER REGISTRATION PACKAGE
The Boys and Girls Club of Kamloops are once again proud to offer fun, safe and engaging
summer programming at John Tod Centre for children aged 5 through 12.
Children must be enrolled in Grade 1 for September 2015 to be eligible for registration
Please indicate which week(s) you would like to register your child in our SUN FUN Program:
SUN FUN – Week 1
July 6th – July 10th
$125
SUN FUN – Week 2
July 13th – July 17th
$125
SUN FUN – Week 3
July 20th – July 24th
$125
SUN FUN – Week 4
July 27th – July 31st
$125
SUN FUN – Week 5
August 4th – August 7th
$100
SUN FUN – Week 6
August 10th – August 14th
$125
SUN FUN – Week 7 August 17th – August 21st
$125
SUN FUN – Week 8
August 24th – August 28th
SUN FUN – Week 9
August 31st – September 4th $125
$125
Total Amount Owing: ___________
HOURS OF OPERATION
Sign In and Supervised Free Time: 8:15am – 9:00am
Programming will be between: 9:30am – 4:00pm
Pick Up and supervised Free Time: 4:00pm – 5:15pm
*PLEASE NOTE – Absolutely NO drop off before 8:15am and NO pick up beyond 5:15pm*
Parents must physically sign in their child(ren) at the beginning of the day and physically sign out
their child(ren) at the end of the day
Boys & Girls Club of Kamloops
SUMMER REGISTRATION
A good place to be
Wild, Wild West
Take a trip back in time to the days of old, to learn
and experience what life was like for pioneers.
Don’t be afraid to get your shoes dirty on the farm
or your hands wet panning for gold. Who knows,
you might even find a souvenir to take home!
Peace Out!
Get your groove on this week, with a flashback to
glowing black lights and flashing disco balls. Enjoy
retro activities of decades past with splashes of
bright colours and tie dye.
Sports Fan-tastic
Get your game face on, and join your team on its
journey to the podium! With relays, obstacle
courses, and other team challenges, you will get
to cheer each other on to the finish line.
Commotion in the Ocean
You may live in a desert, but that doesn’t mean
we can’t bring the ocean to you! From sand castle
building to jumping the waves, you will get to run,
jump, and play in sand, water, and sun.
Superhero Academy
Become your favourite superhero and put your
imagination to work! Create capes, masks, and
belts with super powers. Then you will be ready
to set off on a mission to SAVE THE WORLD, with
some superhero games!
Go GREEN!
Become the world’s superhero, and save the Earth
one composted apple, one piece of picked up
garbage, and one switched off light at a time!
Explore and see where our water comes from, and
what happens to our garbage and recycling.
Into the Wild
Find your wild side, discovering the many lakes
and trails Kamloops and area has to offer. Learn
some survival tips, and enjoy a s’more or two, as
your explore the great outdoors!
Tech Savvy
Behind each app, video game, YouTube video, and
selfie, is a world of technology. Learn how to surf,
post, and socialize safely in the online world, and
put your tech savvy imagination to work, and
become a creator, inventor, and designer!
Wacky Science
Goo and slime, explosions, and eruptions, we have
got it all! So put your safety glasses on, button
that lab coat, and get ready to mix, shake, and
mold, and see what kind of wacky week you will
have!
Pay it Forward
Without the support of the community, this year’s
Sun Fun Summer Camps wouldn’t be possible.
Let’s lend a hand to our neighbours, give back to
those who have given to us, and experience the
difference you can make in someone’s life.
Travel the World
Create your own passport, and collect a stamp
from each “country” you visit this week. Enjoy a
variety of cultural experiences, and learn about
the different ways of travel, making different
ethnic crafts as well.
In addition to the weekly themed field trips and
activities, children will be participating in a
variety of crafts and games. For children aged 712, they will be swimming twice a week, and
children aged 5-6 will get to cool off at the many
water parks Kamloops has to offer.
SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
SUMMER REGISTRATION IS NOT COMPLETE UNTIL ALL DOCUMENTATION IS RECEIVED AND DEPOSITS
ARE PAID
SECTION 1 – MEMBER INFORMATION
Child’s First Name: ______________________________________________ Middle Initial: ________________
Child’s Last Name: ___________________________________________________________________________
Address: __________________________________________________________________________________
Home Phone: ________________________________
Cell Phone: __________________________________
City: _______________________________________
Postal Code: __________________________________
Date of Birth:
______________________________
Current Member?
Yes
Male:
Female:
No
Height: _______________ Weight: ______________ Eye Colour: _____________ Hair Colour: _____________
Skin Colour: __________________ Physical Markings: _______________________ Language: ______________
SECTION 2 – PARENT/GUARDIAN INFORMATION
Mother/Guardian Name: ___________________________________________________________________
Day time/Work Phone: __________________________
Cell Phone: _________________________________
Email: _____________________________________________________________________________________
Father/Guardian Name: ____________________________________________________________________
Day time/Work Phone: __________________________
Cell Phone: _________________________________
Email: _____________________________________________________________________________________
Member currently lives with:
Both parents
Shared Custody
Custody Arrangement:
Yes IF YES, YOU MUST PROVIDE THE CUSTODY/COURT ORDER
No
Mother
Other:
Father
Foster Care
SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
At the end of each program day, children 12 years of age and younger must be picked up by their
parent/guardian or a responsible adult who has been registered with the Club as an emergency contact
or alternate pick-up. Children cannot leave Club programs accompanied by an unregistered person. In
some individual circumstances, other options may be possible, but prior written arrangements must be
submitted to the Program Leader.
SECTION 3 – EMERGENCY INFORMATION
Emergency Contact #1:
Name: _________________________________________________ Relationship: _______________________
Phone: __________________________________ Alternate Phone: __________________________________
Emergency Contact #2:
Name: _________________________________________________ Relationship: _______________________
Phone: __________________________________ Alternate Phone: __________________________________
SECTION 4 – HEALTH & SPECIAL CONSIDERATIONS
Child’s Medical #: ______________________________________________________________________
Doctor’s Name: ___________________________________ Doctor’s Phone#: ____________________
Medications? _________________________________________________________________________
Is the Boys and Girls Club required to administer medication? Yes
No
If so, please explain:
_____________________________________________________________________________________
_____________________________________________________________________________________
Behavioural Concerns:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Is a care plan (behaviour plan) required?
Yes
No
Food Allergies OR Dietary Concerns?: _____________________________________________________
**All care plans must be completed with a Boys and Girls Club Leader prior to child attending **
SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
SECTION 5 - WAIVERS
PERMISSION TO TRANSPORT
I give permission for my child to travel in vehicles operated by the Boys & Girls Club of Kamloops for the purposes of field trips.
I understand that the van driver is fully qualified to operate Club vehicles and that seatbelt use (where available) will be strictly
enforced.
 I have read, understand and agree to the above statement.
VISUAL IMAGE PERMISSION
I give permission for visual images (photos, video, film, etc.) of my child to be included in television, print, website promotion or
publicity for and about the Boys & Girls Club activities and events.
 I have read, understand and agree to the above statement.
 I do not give permission for visual images of my child.
CHILDREN LEAVING THE CLUB
Parents/Guardians must sign their child(ren) out each day. Any alternate pick-up person(s) must be named in writing to the
Program Leader prior to picking up the child(ren), and must present their ID to staff person upon sign-out.
 I have read, understand and agree to the above statement.
MEDICAL WAIVER
I have fully disclosed, to the best of my knowledge, any physical or health issues that could potentially affect my child’s
participation in Club programs or activities. I authorize the leader of the program to obtain such medical advice and services as
he/she deems necessary for the health and safety of my child. In respect of medical services which requires a consent of
parent/guardian, I authorize the leader of the program to provide such consent when all reasonable attempts to contact either
me or other parent or guardian of my child has failed, or where due to the nature of the emergency, there is insufficient time to
contact me or such other parent or guardian. I accept financial responsibility for all medical costs which exceed coverage
provided by the British Columbia Medical Services Plan.
 I have read, understand and agree to the above statement.
RELEASE OF LIABILITY
I acknowledge that by contracting with the Boys & Girls Club of Kamloops, I am aware of the risks involved in the activities my
minor child will be participating in at the Club. Further, in consideration of him/her being permitted to come onto property
owned, leased, or contracted by the Boys & Girls Club and participating in services contracted by myself, in the event of any
accident, injury or sickness regarding my minor child, myself, any spouse of mine, and as parent/guardian of my minor child, do
hereby agree to release and discharge the Boys & Girls Club of Kamloops, its officers, servants, volunteers, and employees from
all liability claims, and courses of action of every nature, whatsoever arising out of such use of properties and services
contracted by myself, for my minor child and every member of the group of which my child is a member of.
 I have read, understand and agree to the above statement.
AGREEMENT TO FOLLOW GUIDELINES FORM
The Boys & Girls Club of Kamloops operates our Club programs within the terms of our program operations and behavioural
guidelines. It is required that all parents/guardians understand and comply with these guidelines. A copy of our Club programs
guidelines is available to download at each program link on our website. As well, printed copies are available at each Club
location.
 I agree to read and abide by the Club Programs Guidelines and to direct any questions or concerns that I may have about
these guidelines to the Manager of Program Operations.
CANCELLATION POLICY
I acknowledge that any changes I request to be made to my child(ren)’s registration will incur a $25 administration fee per
change per child, and any cancellations made after June 19th for the month of July and after July 17th for the month of August,
are non-refundable.
 I have read, understand and agree to the above statement.
SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
SECTION 5 – WAIVERS CONTINUED
PHOTO & IMMUNIZATION RECORDS
 I agree to provide a current photo of my child prior to my child attending programs.
Please check ONE of the following boxes:
 My child’s immunizations are up-to date to the best of my knowledge.
 My child’s immunizations are NOT up-to-date to the best of my knowledge.

WHY DO I HAVE TO PROVIDE PERSONAL INFORMATION?
Information is collected for the registration purposes to ensure that we provide a safe and supported environment consistent
with the needs of your child(ren).
This organization is supported by a variety of funding sources, such as grants from the United Way. Some of these funding
organizations require that we provide demographics reporting, detailing how different groups are served by our organization.
The information you provide is completely confidential and collected for group reporting purposes.
_____________________________________
_________________________
Parent/Guardian Signature
Staff Initials
SECTION 6 – PAYMENT INFORMATION
Method of Payment:
Pre-authorized DEBIT (billed on the 15th)
Cash
Pre-authorized CREDIT (billed on the 15th)
Post-Dated Cheques
Subsidy
Authorization # ___________________________________________________
Club Subsidy/Campership is available. Please inquire with the Boys and Girls Club for more details.
**Pre-authorization forms must be filled out at time of registration**
***Subsidy paperwork must be submitted and approved prior to child attending***
***************OFFICE USE ONLY***************
TOTAL AMOUNT OWED $_______________ TOTAL RECEIVED $_____________
OUTSTANDING AMOUNT OWED: $____________
Date: ___________________
FUTURE PAYMENTS
Cash
PAC
Staff Authorization: ____________________
PAD
Cheques
Cheques
Credit Card
SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
PARENT/GUARDIAN INFORMATION SHEET
(PLEASE KEEP THIS SHEET FOR YOUR REFERENCE)
PAYMENT INFORMATION
*ALL FEES MUST BE PAID IN FULL PRIOR TO THE START OF CAMP*



Pre-authorized Debit and Credit will be debited on the 15th of July & August 2015.
10% deposit required at time of registration
All parents using government subsidy MUST have a current subsidy number in order to
register. Without a current government issued subsidy authorization number, you will
incur the fees upon registration.
CANCELLATION NOTICE
There will be a $25 administration fee per change per child after initial registration.
A zero (0) refund policy will be in effect for cancellation made after June 19th for the month of
July, and after July 17th for the month of August.
SUN FUN Program Dates and Registration Fee:
SUN FUN – Week 1
July 6th – July 10th
$125
SUN FUN – Week 2
July 13th – July 17th
$125
SUN FUN – Week 3
July 20th – July 24th
$125
SUN FUN – Week 4
July 27th – July 31st
$125
SUN FUN – Week 5
August 3rd – August 7th
$125
SUN FUN – Week 6
August 10th – August 14th
$125
SUN FUN – Week 7
August 17th – August 21st
$125
SUN FUN – Week 8
August 24th – August 28th
$125
SUN FUN – Week 9
August 31st – September 4th
$125
Total Amount Owing: ___________
SUMMER REGISTRATION
Boys & Girls Club of Kamloops
A good place to be
A DAY IN THE LIFE…
Please make sure your child brings the following items everyday:
1.
2.
3.
4.
5.
6.
7.
8.
9.
A healthy and nutritious lunch and snacks
A water bottle with their name on it
Appropriate footwear
A hat
Sunscreen (preferably spray sunscreen) and please make sure you apply sunscreen
before arrival
Bathing suit and towel
A backpack with zippers and shoulder straps. Plastic Bags prove over and over again to be
unsuccessful
A smile!
Please make sure your child’s clothing is labeled with his or her name
HOURS OF OPERATION
Sign In and Supervised Free Time: 8:15am - 9:30am
Programming will be between: 9:30am - 4:00pm
Pick Up and Supervised Free Time: 4:00pm – 5:15pm
*PLEASE NOTE – Absolutely NO drop off before 8:15am and NO pick up beyond 5:15pm*
Parents must physically sign in their child(ren) at the beginning of the day and physically sign out
their child(ren) at the end of the day
If you have any questions please contact us: 250-554-5437
Or visit our website: www.bgckamloops.com